Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
TC99M DISOFENIN PER STUDY DOSE =< 15 MCI ; X1 MAX [NM]
Low
$0
Average
$213
Median
$157
High
$625
Each hospital's average Ambetter rate, under the methodology and billing class chosen below.
36 hospitals; the 90th percentile is 13.6× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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36 hospital rates
iThe hospitals that file a Ambetter rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Alleghany County Memorial Hospital, Inc Sparta, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $53 | $53 | $27 | 50% | — | $26 – $80 |
| 2 | BURLESON ST. JOSEPH HEALTH CENTER OF CALDWELL, TEXAS Caldwell, TX fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 3 | CentraState Medical Center Freehold Township, NJ other · outpatient | 1 | $625 | $625 | — | — | — | $625 – $625 |
| 4 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $297 | $297 | — | — | — | $297 – $297 |
| 5 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 6 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 1 | $625 | $625 | — | — | — | $625 – $625 |
| 7 | Deaconess Hospital, Inc Newburgh, IN professional · percent of total billed charges · bothfrom % of charges | 1 | $65 | $65 | — | — | — | $65 – $65 |
| 8 | Dickenson Community Hospital CLINTWOOD, VA percent of total billed charges · bothfrom % of charges | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 9 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 1 | $625 | $625 | — | — | — | $625 – $625 |
| 10 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $210 | $210 | $7 | 3% | — | $203 – $216 |
| 11 | Johnson County Community Hospital MOUNTAIN CITY, TN percent of total billed charges · bothfrom % of charges | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 12 | Lee County Community Hospital PENNINGTON GAP, VA percent of total billed charges · bothfrom % of charges | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 13 | Little Company of Mary Hospital of Indiana Inc Jasper, IN professional · percent of total billed charges · bothfrom % of charges | 1 | $65 | $65 | — | — | — | $65 – $65 |
| 14 | MADISON ST JOSEPH HEALTH CENTER Madisonville, TX fee schedule · outpatient | 1 | $92 | $92 | — | — | — | $92 – $92 |
| 15 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 3 | $101 | $95 | $39 | 41% | — | $45 – $140 |
| 16 | Mercy Hospital Aurora Aurora, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $158 | $158 | — | — | — | $158 – $158 |
| 17 | Mercy Hospital Cassville Knob, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $162 | $162 | — | — | — | $162 – $162 |
| 18 | Mercy Hospital Lebanon dba Mercy Hospital Lebanon Rolla, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 19 | Mercy Hospital Springfield Ozark, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $197 | $197 | — | — | — | $197 – $197 |
| 20 | Mercy Hospital Springfield Springfield, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $197 | $197 | — | — | — | $197 – $197 |
| 21 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $234 | $234 | — | — | — | $234 – $234 |
| 22 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $320 | $320 | — | — | — | $320 – $320 |
| 23 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $228 | $228 | — | — | — | $228 – $228 |
| 24 | Mercy Perry Perryville, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 25 | Morristown Medical Center Morristown, NJ other · outpatient | 1 | $625 | $625 | — | — | — | $625 – $625 |
← Payers reporting HCPCS A9510 · Snapshot 20261111T120946Z-9134e7f7